CT-guided drainage of a brainstem abscess in a cat as an emergency treatment procedure

Bersan, Erika, Maddox, Thomas, Walmsley, Gemma, Piviani, Martina and Burrow, Rachel (2020) CT-guided drainage of a brainstem abscess in a cat as an emergency treatment procedure. JOURNAL OF FELINE MEDICINE AND SURGERY OPEN REPORTS, 6 (1). 2055116919896111-.

Access the full-text of this item by clicking on the Open Access link.

Text
2055116919896111.pdf - Published version
Download (886kB) | Preview

Official URL: http://dx.doi.org/10.1177/2055116919896111

Abstract

<h4>Case summary</h4>A 3-year-old male neutered domestic shorthair cat was presented with a 1-week progressive and rapidly deteriorating history of lethargy and abnormal behaviour. Neurolocalisation indicated multifocal intracranial lesions (right oculomotor nerve, brainstem [obtundation, non-ambulatory tetraparesis, vestibular dysfunction and intermittent decerebrate rigidity] and possibly the thalamus [left-sided pleurothotonus]), or more likely a single brainstem lesion with mass effect. MRI of the brain demonstrated a brainstem abscess causing severe dorsal displacement particularly affecting the pons and the medulla oblongata causing cerebellar vermis herniation through the foramen magnum. CT-guided free-hand technique drainage of the brain abscess was performed and broad spectrum antibiotics were started based on sensitivity results. The cat recovered uneventfully from anaesthesia displaying marked improvement immediately after the procedure. Antibiotics were continued for 8 months; repeat imaging prior to withdrawal found complete resolution of the brainstem abscess.<h4>Relevance and novel information</h4>Free-hand CT-guided drainage of a brainstem abscess is not without risk; however, in this case it led to significant clinical improvement and stabilisation likely owing to reduced intracranial pressure. It also provided a diagnostic sample that allowed successful medical treatment planning and outcome. To our knowledge, this is the first report describing the successful management of a brainstem abscess by CT-guided drainage in the veterinary literature. It suggests that stereotactic drainage followed by medical therapy can be considered a successful therapeutic alternative to brain surgery or medical treatment alone, providing an emergency treatment in cases of acute brainstem dysfunction.

Item Type:	Article
Uncontrolled Keywords:	Brainstem abscess, brain abscess, intracranial abscess, computed tomography (CT)-guided drainage, medical treatment, bacterial meningitis, meningoencephalitis, CT, MRI
Depositing User:	Symplectic Admin
Date Deposited:	02 Mar 2020 11:24
Last Modified:	19 Jan 2023 00:00
DOI:	10.1177/2055116919896111
Open Access URL:	https://doi.org/10.1177/2055116919896111
Related URLs:	Author Publisher
URI:	https://livrepository.liverpool.ac.uk/id/eprint/3076880